Migrating Thrombus Trapped in a Patent Foramen Ovale

Kessel-Schaefer, Arnheid; Lefkovits, Michael; Zellweger, Michael J.; Brett, W.; Rüter, Florian; Pfisterer, Matthias; Buser, Peter

doi:10.1161/01.cir.103.14.1928

Cited by 28 publications

(21 citation statements)

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“…First, PFO-mediated paradoxical embolism is pathophysiologically plausible, and thrombus trapped within the PFO has been documented iteratively (21)(22)(23). Second, larger PFO size has been associated with a higher recurrence rate, suggesting a dose-response relationship (24 -28).…”

Section: Discussionmentioning

confidence: 99%

Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke

Windecker

Wahl

Nedeltchev

et al. 2004

Journal of the American College of Cardiology

284

129

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Section: Discussionmentioning

confidence: 99%

Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke

Windecker

Wahl

Nedeltchev

et al. 2004

Journal of the American College of Cardiology

284

129

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“…In very rare cases, echocardiography or autopsy discloses a thrombus trapped in the cardiac RLS and thus unequivocally proves the paradoxical embolism. 3,4 About 30% of the general population show a cardiac RLS, in most cases a patent foramen ovale. Juvenile patients with otherwise not explainable stroke have a much higher cardiac RLS prevalence of Ϸ50%.…”

mentioning

confidence: 99%

Optimizing the Technique of Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Droste

Lakemeier

Wichter

et al. 2002

Stroke

106

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Background and Purpose-A cardiac right-to-left shunt (RLS) can be identified by transesophageal echocardiography and transcranial Doppler ultrasound (TCD) with contrast agents and a Valsalva maneuver (VM) as a provocation procedure. This article applies the modalities of these tests detailed in previous studies to a large patient cohort and compares 2 contrast agents (saline and Echovist-300). Methods-Eighty-one patients were investigated by both transesophageal echocardiography and bilateral TCD of the middle cerebral arteries. The following protocol with injections of 10 mL agitated saline was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, and (3) repetition of the test with VM if the first test with VM was negative. The VM was performed for 5 seconds starting exactly 5 seconds after the beginning of saline injection. Thereafter, the same protocol was repeated with 10 mL Echovist-300 instead of saline. Results-Thirty-one patients had a cardiac RLS. The Echovist-300 investigation disclosed all these 31 shunts, but saline disclosed only 29 of them. Twenty-two had an RLS only in at least 1 of the above TCD tests, some of them even with a considerable shunt volume. Conclusions-Contrast TCD performed with Echovist-300 but not with saline yields a 100% sensitivity to identify transesophageal echocardiography-proven cardiac RLSs. The TCD test should be repeated if negative the first time. This article gives detailed information for the optimization of the contrast TCD technique. Extracardiac shunts detected only during contrast TCD can have a considerable shunt volume and may allow for paradoxical embolism. Key Words: cerebral embolism Ⅲ cerebrovascular disorders Ⅲ foramen ovale, patent Ⅲ ultrasonography P aradoxical emboli of thrombotic material originating from the deep leg or pelvic veins via a cardiac or extracardiac right-to-left shunt (RLS) can cause ischemic stroke. 1,2 Prerequisites for the diagnosis of paradoxical brain embolism are the demonstration of such a shunt, the presence of an embolic pattern of infarction on cerebral imaging, and the absence of competing stroke origins. Other factors such as the performance of a mostly incidental Valsalva maneuver (VM) before the onset of infarction, the demonstration of remnants of the venous thrombosis during crural venous ultrasound or phlebography, concomitant pulmonary embolism, thrombophilia, and other factors predisposing to venous thrombosis additionally support the diagnosis. In very rare cases, echocardiography or autopsy discloses a thrombus trapped in the cardiac RLS and thus unequivocally proves the paradoxical embolism. 3,4 About 30% of the general population show a cardiac RLS, in most cases a patent foramen ovale. Juvenile patients with otherwise not explainable stroke have a much higher cardiac RLS prevalence of Ϸ50%. 5,6 This fact corroborates the importance of paradoxical embolism in stroke origin. Extracardiac shunts, mainly pulmonary ones, can also deliver a substantial...

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“…Patients with pulmonary embolism and PFO diameter >4 mm have 10 fold higher risk of death and 5 fold higher risk of systemic embolism than patients without PFO [10]. The diagnosis of paradoxical embolism requires the simultaneous presence of venous thrombosis or pulmonary embolism without thrombi in the left section of the heart and/or in aorta, PFO and systemic arterial embolism [11].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and Paradoxical Embolism after Fracture of the Big Toe in a Patient with Patent Foramen Ovale

Facciorusso¹

2012

J Clin Exp Cardiolog

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Migrating Thrombus Trapped in a Patent Foramen Ovale

Cited by 28 publications

References 0 publications

Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke

Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke

Optimizing the Technique of Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Pulmonary and Paradoxical Embolism after Fracture of the Big Toe in a Patient with Patent Foramen Ovale

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